Request for Service First Name Last Name Phone Email Address If you are in immediate danger, please call 911 If you need immediate medical attention, please go to your local hospital If you are in crisis or would like to talk to someone right away, please call The Helpline at 1-800-494-8100. Day One offices can be reached directly at 401-421-4100 Monday through Friday 8am-5pm What is the best and safest way to contact you? Phone Email Mail May we identify ourselves as Day One when we contact you? Yes No When is the best time to contact you? Any other specific contact instructions/limitations I am interested in (check as many as apply) Scheduling an appointment with a clinician/counselor for myself and/or my child Trauma Yoga program Support Groups Talking to an Advocate about the status of my legal case or other legal questions Talking to an Advocate about what all of my options are Talking to someone about my child’s concerning behaviors Talking to someone about the CAC and what to expect Services available at Day One Having someone from Day One conduct a professional presentation for an organization I am affiliated with Having someone from Day One conduct a prevention education program for an organization/school I am affiliated with Other I am interested in (check as many as apply) Other Additional information/Questions
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